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Whenever I drive through the province of Sindh in southern Pakistan, I’m struck by the vast expanse of once-thriving farmland that now lies barren. Standing water from last year’s catastrophic floods has ensured there will be no harvest here – in Pakistan’s agricultural heartland – for some time to come. Six months after the flooding began, many of the families who fled their villages are returning to their houses. But being away from their homes and livelihoods with limited access to food, clean water, and healthcare has caused an alarming number of children to become malnourished. That is why I am here.

Figures released last week indicate that nearly one in four children in northern Sindh are acutely malnourished and therefore at much higher risk of severe illness and death. We knew the situation was bad; we could see it in the camps, villages, and the overwhelming numbers of children in our treatment centres, but we didn’t know it had reached this scale. It is now thought that 100,000 children in this area are malnourished or will become malnourished in the coming months. Figures like these tell us that we have to do more, and fast.

On Tuesday, I visited a nutrition centre – one of many that has been set up across Sindh – where Save the Children is treating malnourished children. At the centre, I spoke to Khatoon, whose seven month old son Waqar is being treated for severe malnutrition. Khatoon told me about the difficulties her family have faced since the floods hit.

“We were in our home when suddenly the flood water came. We took our children, hurried away and slept in open land. We had no shelter and lost everything. All we had were the clothes we were wearing. We were hungry and had nothing to eat for a long time. Now the water has gone down and we have moved back to the village. Our house has been completely destroyed so we are trying to rebuild it using wood from fallen trees. In our village, conditions are bad, there are a lot of pregnant women who are very weak and many children are becoming very sick.”

Shortly after Khatoon and Waqar left, another mother, Satbai, arrived with her three-month-old baby, Samani, who was too weak to even cry. He needed specialist treatment and had to be transferred to the district hospital for round-the-clock care by Save the Children’s medical staff. Satbai told me that she has been unable to produce breastmilk and had been feeding him water and biscuits instead.

It is not uncommon for mothers to lose the ability to breastfeed in the aftermath of an emergency, as stress can interrupt the flow of milk. But something as simple as this represents a huge threat to very young children, for whom breastmilk is a key source of nutrition. Not knowing what else she could do, Satbai fed her son water and crushed biscuits but the water was dirty and he became sick. Thankfully, Samani will receive treatment in our centre and Satbai will get the support she needs to restart breastfeeding.

I hear stories like this every day. While I know that children like Samani who receive help will recover, I wonder about those who cannot get to a treatment centre. What will happen to them?

It’s some comfort to know that in the coming weeks, Save the Children will be quadrupling the number of treatment sites in this area. We will be reaching many more children, but with so many already malnourished or at risk of becoming malnourished, there are many difficult days ahead. Helping Pakistan rebuild and recover is going to take time, and we will need all the support we can get to ensure the country’s most vulnerable children receive the help they so desperately need.

Alison Donnelly, a Save the Children Nutrition Adviser working in Sindh